Private AIDS clinic brings hope to Abidjan slum

For Swiss-born Lotti Latrous, founder of a private AIDS clinic in the slums of Abidjan, Cote d’Ivoire’s economic hub, the cup is never half empty, but always half full. In other words, she is an optimist. “Of 640 people hospitalized over the past two years, half of them died,” she said, leafing through a large notebook. She sighed, looked away and managed a smile. “But the good news is that the others all went home.” Few health clinics in Abidjan are as efficiently run as ‘Centre l’Espoir’ - which means ‘The Hope Centre’ in French. It is built smack in the middle of one of the poorest neighborhoods of Abidjan - Adjouffou, an area of sandy flat land near the city's airport. From all over Abidjan, people living with AIDS find their way to this clinic. They often arrive there after having spent all their money on medical bills to consult doctors who are afraid to tell them what they really suffer from. Latrous was a housewife and a mother of three when she befriended an Ivorian doctor who invited her to assist him while he gave free consultations in Adjouffou. Affordable basic health care was non-existent in Abidjan at the time. Before long, she began using her contacts within the expatriate community to raise funds for a small clinic. She opened a dispensary in 1999. Three-and-a-half years later, a second building was inaugurated, focusing on adults in an advanced stage of AIDS. Today, Latrous, who is in her early fifties, not only runs the clinic - she also lives here, in a tiny room next to ‘her’ patients. Pictures of her children, who live with her husband in Egypt, decorate the wall alongside her bed. The dispensary consists of roofed-over containers housing a laboratory, an office, two sick rooms for day patients and a pharmacy. The AIDS clinic is housed in a separate low brick building with a large open-air courtyard where some patients sit chatting around a table, while others snooze comfortably on sofas. Latrous believes that the HIV prevalence rate in this poor neighbourhood is much higher than the official average of 9.5 percent for Cote d'Ivoire as a whole. This country, which has been partitioned by civil war for the past two years, has the highest rate of HIV prevalence in West Africa. And although it remains the most prosperous country in the region, many of its inhabitants are still very poor. “A lot of people can only afford one meal a day, which costs about as much as one condom,” Latrous said. “In the dispensary, we started receiving a lot of people with possible symptoms of AIDS, such as diarrhea, tuberculosis and weight loss. So I decided to offer free blood tests. And what I saw was really, really frightening: of the generation born between 1960 and 1975, seven out of 10 people tested positive.” The dispensary offers basic medical care to everyone at only 300 CFA francs (55 US cents) per visit. In five years it has carried out over 100,000 consultations. Latrous’ indefatigability, her frank manner of speaking about HIV/AIDS and her caring, almost motherly approach to people living with the virus have earned her centre its reputation as a uniquely successful AIDS clinic. Latrous believes that the main problem with AIDS in Cote d'Ivoire, apart from poverty, is taking the test. “Public hospitals do not offer to test for HIV, even if a patient has all the symptoms of AIDS. Doctors are afraid to tell the truth. And they make more money this way. I once had a boy here with a letter from a public hospital saying: ‘Please tell this young man he has AIDS’. This is typical.” Latrous said most Ivorians do not know that antiretroviral (ARV) drugs, which are nowadays available at the government subsidised price of 5,000 CFA (US $9) per month, can prolong their lifespan by years, if not decades. So how does Latrous break the news? “The day they find out they are seropositive is perhaps the best in their life. That is what I tell them. Because you can not fight an illness you don’t know. It’s like a ghost, invisible. You can only start fighting it the day you know what it is. A lot of these poor people have spent a fortune on hospital bills. Now they can finally try to get better.” Centre l’Espoir runs entirely on gifts and donations. The nurses and doctors are Ivorian. Two women of the Abidjan expatriate community help out as volunteers. Several members of staff are HIV-positive, including a watchman, the handyman and the female cooks. Within the enclosure of the clinic, the subject of HIV/AIDS is discussed more or less openly among staff members. But within the surrounding neighbourhood, the topic remains taboo, despite Latrous’ near celebrity status. “I have the hardest time finding a garbage collector, because nobody will touch our garbage,” Latrous said. “On the other hand, we can hang our sheets out to dry anywhere we want, because nobody will steal them.” Most of the patients in Centre l’Espoir are women. Latrous is critical of African men - she thinks they have no sense of responsibility. “African women think about their children first, that is why they will take the test: they do not want their children to be orphans. But the men - they are always afraid. They all have girlfriends on the side and they do not want to know the truth. They would rather ‘share’ their sickness with their wife.” Thanks to the Centre l'Espoir, many Ivorian women will admit openly that they are living with HIV/AIDS. Earlier this year, Awa was brought in helpless, dazed and skinny as a stick. Today, she is a healthy young woman with sparkling eyes who says she owes her life to Lotti Latrous. “Madame Lotti told me that I was seropositive, but it did not mean I’d have to die. I take ARV’s now and I feel fine. There is nothing wrong with me, and this is what I try to tell other people: it’s possible to live with HIV/AIDS.” Awa shares a small apartment with her mother and her six-year-old son. “Of course, I take my precautions. I have my own toothbrush and razor blade and I make sure that no one else uses them. You see, in this neighborhood, people even share basic things like a toothbrush.”